POSTER SESSION 2008 P1. OUTCOMES OF LAPAROSCOPIC FUNDOPLICATION VS. LAPAROSCOPIC GASTRIC BYPASS IN MORBIDLY OBESE WITH GASTROESOPHAGEAL REFLUX DISEASE Esteban Varela, MD, MPH 1 ; Marcelo W. Hinojosa, MD 2 ; Ninh T. Nguyen, MD 2 ; 1 Surgery, UT Southwestern, Dallas, TX, USA.; 2 UC Irvine, Orange, CA, USA. Background: Gastroesophageal reflux disease (GERD) is com- monly associated with morbid obesity. Laparoscopic fundoplica- tion is the standard surgical treatment for GERD. However, lapa- roscopic gastric bypass has shown to effectively resolve GERD symptoms in morbidly obese. The outcomes of laparoscopic fun- doplication and gastric bypass in morbidly obese with GERD were compared at US academic medical centers. Methods: Using ICD-9 procedural code diagnoses for 27,264 morbidly obese patients with GERD diagnosis who underwent laparoscopic fun- doplication or laparoscopic gastric bypass were identified from the Uni- versity Health-System Consortium Database over a 5-year period (2003- 2007). Outcomes measured included patient’s demographics, length of stay (LOS), in-hospital overall complications, mortality, risk adjusted mortality ratio (observed/expected mortality) and hospital costs. Results: Table Conclusion: In morbidly obese patients with GERD symptoms, lapa- roscopic gastric bypass is associated with significantly shorter length of stay and overall complications when compared to laparoscopic fundoplication. Both procedures appear to be safe with similar hos- pital costs. Laparoscopic gastric bypass should be offered to morbidly obese patients when GERD is present as comorbid condition. Variable Laparoscopic fundoplication Laparoscopic gastric bypass N 6,108 21,156 Female % 57 83 Caucasian % 78 74 Length of stay (days) 5  11 3  2 Complications % 13 7 Mortality % 0.1 0.1 Risk-adjusted mortality ratio 0.2 0.7 Costs \$ 13,100  22,600 13,200  7,600 Values=Mean  SD; *=p.05 by Z-test; †=p.05 by t-test; PII: S1550-7289(08)00299-2 P2. CENTRAL VENOUS LINE PLACEMENT PRIOR TO GASTRIC BYPASS IMPROVES O.R. EFFICIENCY David W. Overby, MD; Karen Colton, RN; Joseph M. Stavas, MD; Robert G. Dixon, MD; Timothy M. Farrell, MD; Surgery, UNC Chapel Hill SOM, Chapel Hill, NC, USA. Background: Bariatric surgery is increasing across the U.S. Achieving venous access is one challenging aspect in the imme- diate preoperative period. When preoperative efforts fail, anesthe- siologists often utilize valuable OR time acquiring reliable intra- venous lines. These services may not be compensated and can prevent other billable activity. Methods: In our practice, selected bariatric surgery patients are referred for outpatient preoperative placement of prophylactic in- ferior vena cava (IVC) filters in Interventional Radiology. Since 2003, these patients have received central venous lines (CVL) at the completion of the IVC filter placement. We identified 269 patients who had gastric bypass between 1/01 and 11/06, and queried operating room databases to compare time between patient OR entry and skin incision (“in-to-skin”) for patients with and without central venous access. In addition, we searched billing databases for CVL collection rates. Non-paired t-test was used for comparison of continuous data. Results: Patients with preoperative CVL had mean “in-to-skin” time of 35.6 +/- 12.5 minutes versus 42.5 +/- 13.9 minutes for those without preoperative CVL (p 0.0001). When assessed in quarter-hour increments, the presence of a preoperative CVL was associated with 34.9% of preop-CVL patients having skin incision by 30 minutes versus 16.36% of non-preop-CVL patients (graph). Regarding reimbursement, interventional radiologists collected 28.2% of billings for CPT code 36556, compared with anesthesi- ologist who collected less than 1% when placing CVL in the OR. Conclusion: Outpatient placement of central line prior to gastric bypass improves the efficiency of the operating room with earlier skin incision. Professional reimbursement is better for preoperative outpatient CVL placement than intraoperative placement. Surgery for Obesity and Related Diseases 4 (2008) 312–357 1550-7289/08/$ – see front matter © 2008 American Society for Bariatric Surgery. All rights reserved.